Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis

Abstract

Lateral epicondylitis usually responds well to nonoperative management. A limited number of refractory cases may require surgical intervention. The objective of this study was to assess the outcome of arthroscopic release of the extensor carpi radialis brevis (ECRB) tendon in a consecutive series of patients. A retrospective review of 36 patients with lateral epicondylitis treated surgically between January 2001 and January 2004 was performed. There were 24 men and 12 women averaging 42 years at the time of surgery. In all patients, nonoperative management failed, and they underwent surgery at a mean of 19 months after the onset of symptoms. An arthroscopic release of the ECRB was performed. Data collection was performed by an independent examiner. Operative findings included 28% of patients with significant intra-articular synovitis and 36% with a Baker type 1 lesion, 39% with a type 2 lesion, and 25% with a type 3 lesion. At a mean follow-up of 3.5 years, the mean Mayo Clinic elbow score was 11.1 (range, 5 to 12). By use of visual analog scales, pain improved from 1.5 +/- 1.3 preoperatively to 8.1 +/- 2.4 at follow-up (P < .01). Of the patients, 10 (31%) reported mild pain with strenuous activities and 2 (6%) received no benefit from the procedure. Patients required a mean of 3.8 weeks to return to regular activities and 7 weeks to return to full work duties. No serious complications were identified. Arthroscopic release of the ECRB is a viable option for recalcitrant lateral epicondylitis. This procedure appears to be safe and effective and allows for management of associated intra-articular pathology.